You’ve been in the top job at the Black Dog Institute since last November. What do you hope to achieve in the role?
The Black Dog Institute has been through an incredible growth phase over the past ten years, both in terms of staff numbers (which have grown from under 100 to over 300) and the impact of our work. My priority is to consolidate that growth and ensure that the important research and implementation work that we are doing is having an impact out in the real world.
Suicide is the leading cause of death among 15 – 44 year-old Australians and mental health symptoms are the number one reason why people present to their GP. Why is mental health at such crisis levels both here and overseas?
I think there are two things at play. First, we are recognising what was always there; for many years, millions of people suffered mental ill health in silence. But there is also overwhelming evidence that the rates of mental illness are increasing, particularly among adolescents and young adults, and the honest answer is that we don’t know why. There is a range of different theories relating to increased inequality, less job security, reduced social cohesion, the rise of social media, and unfiltered information coming through to developing brains. But nobody can say for sure exactly why it’s happening – and that’s one of the big questions we need to answer over the next few years.
Black Dog described the recent Federal budget as “a missed opportunity” for those under 12. How big a problem is mental illness among pre-teens – and how do we get to those who need help early?
The most common age for the onset of mental health symptoms is in the teenage and early adult years – and that’s why so much focus has gone into these age groups. The under 12s have been largely ignored. But studies now show that a significant number of kids in primary school have early symptoms, particularly of anxiety. This can cause distress and dysfunction for some, but the real reason for identifying symptoms at that age is the opportunity for early intervention.
It is far easier to treat symptoms in young kids because their brains are still flexible and designed for learning. So we think it’s a missed opportunity to not trial new ways to try to help primary school children.
Black Dog currently provides free mental health training to small businesses. What does a mentally healthy workplace look like to you – and why is it so important?
The solution to the high rates of mental ill health has to involve society; it is not a problem that the health system alone can deal with. Adults spend most of their waking hours at work, so if we are doing the right thing in the workplace, we are going a long way to reducing the problem.
There are three ways in which a workplace can be truly mentally healthy. First, it can minimise mental health risk factors, like bullying and job insecurity. Some of these factors are not entirely avoidable, but they can be minimised. Secondly, workers need to be able to access help when they need it, without worrying about the loss of their career or any form of stigma. Thirdly, when someone does need time away for mental health treatment, the workplace needs to be part of their recovery and they need to be supported to get back to work.
Research shows that the key to making workplaces mentally healthy is to get managers and leaders trained around mental health. These are the people who can stop or modify the risk factors and help out when workers develop symptoms.
How do you ensure that Black Dog’s cutting-edge research makes it into the hands of those who work on the mental health frontline in a timely manner?
That’s a key issue. On average, it takes about 8 years for important new research to actually change what is happening in schools, workplaces and GP surgeries.
There are two ways we are trying to reduce this lag. First, at Black Dog we have an equal number of researchers and implementation experts. They work hand-in-hand both in defining the research questions and then in putting the research into action. The implementation experts are the people who go out into schools and workplaces and who train the GPs and health workers.
Secondly, we have in place clear rules and a clear framework around research translation. We have set standards of evidence we need to see before we implement something at scale. We are also constantly looking at the research other groups publish to spot opportunities for getting new knowledge and ways of doing things out into the wider world.
Another of your passions is the overlap between physical and mental health. Can you explain more about that?
When I went through medical school, the very clear message we got was that the mind is separate from the rest of the body. When you saw a patient with unclear symptoms, you had a dichotomous decision: was it a physical problem or a mental problem?
That kind of thinking is totally out step with what we now know about just how integrated our brain is with all other bodily systems. In reality, mental health problems are often exacerbated by physical problems – and vice versa. We don’t provide patients with the best care when we try to split the two.
How do we rapidly build the mental health workforce to meet the scale of demand?
I think this is the biggest issue facing the Australian mental health system. We don’t have the number of clinicians required to meet the demand of people asking for help now – never mind all the people we know have symptoms but haven’t yet asked for help.
There are some things that we can do quickly to make better use of our clinical workforce. We can provide blended care, which means combining face-to-face care with apps or online programs. This allows a single psychiatrist or psychologist to see more people per day.
Alongside these types of actions, we need to train more mental health clinicians. But the sad thing is that, at the moment, Australia struggles to find junior doctors who want to train in psychiatry. Part of that is due to the stigma surround mental health, which extends into the medical field. Junior doctors see how under pressure and under-resourced the mental health system is – and they vote with their feet. So it’s not just a case of funding more positions, it’s a case of having to fix the system so that people think they will be able to work in it without burning out.
What does the mental health workforce of the future look like and how do we equip those on the front-line – eg police, teachers, corrections officers – with the capabilities necessary to deal with the problem?
My hope is that the mental health workforce of the future will be larger and far more diverse – both in terms of the backgrounds of workers (so that they better match the communities they work in) and in terms of their skill sets. I don’t just want to see psychiatrists or clinical psychologists, I want to see vocational rehabilitation workers to help people get back to work and a really substantial peer workforce, so that individuals who have experienced mental ill health can help others.
As for front line workers, like teachers and police, they are usually pretty good at spotting the kids who are struggling. However, they don’t have the practical training to know what to do in these situations, like how to have the conversation with the kids and their parents and which services to refer them to. So it’s not about awareness; it’s about practical skills training and making sure they have the resources they need.
Do you have any other updates from The Black Dog Institute?
It’s a very exciting time to be in mental health research. We have been through a number of decades with relatively few breakthroughs in treatments, but there are some really exciting things happening. There are new drugs being developed for depression and anxiety, new talking treatments being devised, and new ways of physically stimulating areas of the brain involved in mood disorders. We are investing heavily in these treatments because I truly believe they will be game changers and improve outcomes for those suffering from depression.
